Khan K N, Nakata K, Shima M, Kusumoto Y, Ishii N, Koji T, Nagataki S
First Department of Internal Medicine, School of Medicine, Nagasaki University, Japan.
Dig Dis Sci. 1993 Jan;38(1):65-70. doi: 10.1007/BF01296775.
We analyzed the serial changes in serum pancreatic enzyme activities by transcatheter arterial embolization (TAE) in 20 hepatoma patients with liver cirrhosis in an attempt to evaluate the incidence of the pancreatic tissue damage by TAE. Serum amylase activities increased in two (10%) cases, elastase 1 levels in six (30%) cases, and trypsin and pancreatic secretory trypsin inhibitor (PSTI) levels in each of five (25%) cases. Consequently, TAE resulted in the elevation of at least more than one serum pancreatic enzyme in eight (40%) of 20 cases, although none had clinical symptoms related to pancreatitis. When the adverse effect on the pancreatic tissue was compared among 6 cases of the superselective TAE and 14 cases of the nonsuperselective TAE, which were performed from the segmental and the nonsegmental hepatic arteries, respectively, the elevation of serum pancreatic enzymes was caused only by nonsuperselective TAE, not by superselective TAE. The volumes of Spongel and Lipiodol used or the injected doses of the anticancer agent mitomycin C were not different between the two groups. These results indicate that TAE for the treatment of hepatoma frequently causes pancreatic tissue damage, and the position of the inserted catheter tip is very important to avoid the pancreatic tissue damage by TAE.
我们分析了20例肝硬化肝癌患者经导管动脉栓塞术（TAE）后血清胰腺酶活性的系列变化，以评估TAE所致胰腺组织损伤的发生率。血清淀粉酶活性在2例（10%）患者中升高，弹性蛋白酶1水平在6例（30%）患者中升高，胰蛋白酶和胰腺分泌性胰蛋白酶抑制剂（PSTI）水平在5例（25%）患者中均升高。因此，20例中有8例（40%）患者TAE后至少有1种血清胰腺酶升高，尽管无一例有与胰腺炎相关的临床症状。当比较分别从节段性肝动脉和非节段性肝动脉进行的6例超选择性TAE和14例非超选择性TAE对胰腺组织的不良反应时，血清胰腺酶升高仅由非超选择性TAE引起，而非超选择性TAE未引起。两组使用的明胶海绵和碘油体积或抗癌药丝裂霉素C的注射剂量无差异。这些结果表明，TAE治疗肝癌常导致胰腺组织损伤，插入导管尖端的位置对于避免TAE所致胰腺组织损伤非常重要。
